Tuesday, October 22, 2013

Ophthalmology Posting in Klaten

Signed. This is a joke! My penlight is functioning, my black torchlight is functioning perfectly! This is so impossible.

This morning, I tried to light my penlight and my black torchlight, they both couldn’t function. So in the end I brought an old lousy blue torchlight to the hospital. Ophthalmology. I needed my penlight more than any other instrument. The ophthalmology specialist in this hospital is famous for her extreme discipline. Even the patients have to sit straight, legs close to each other during consultation. Yes, she is that perfectionist.

And so shit things happened. My lousy torch malfunctioned after the first patient. Great, so I ended up asking for only light perception and not doing light reflex. There was this patient, who could only see darkness. I wrote as “no light perception”, and I just left out light reflex, having no torch to use.

This doctor was so furious. She found that the patient’s light reflex is positive. And she immediately scolded me for writing no light perception. What the hell! Since when light perception equals to light reflex?! A big questions, I asked her. She scolded me even more. Signed. I had met a lot of angry doctors, but none as weird as this. New record, she is the first doctor that said I find excuses for myself. Oh God, since when I am associated with laziness. Just because my penlight spoilt at the wrong time doesn’t make me a lazy doctor who doesn’t wanna do a simple light reflex please.

After dismissed from the hospital, I brought myself a new penlight. And when I reached home, my old penlight and my black torch are both functioning perfectly. Can you believe what just happened? Ridiculous as it is, I take that as a lesson.

I still can’t believe this. My instruments just betrayed me. Tomorrow I am going to bring three torchlights to the hospital. This is so ridiculous.

PS: Light perception DOES NOT equal to light reflex. There is a possibility that Light reflex is normal, but there is no light perception. I couldn’t say the doctor is totally wrong because light reflex and light perception share the same pathway until right before the lateral geniculate body. So logically speaking, it is possible that there is light reflex but there is no light perception if the damage is in the lateral geniculate body, in the optic radiation and visual cortex. So judging on the patient’s condition (Dx cataract), it is unlikely that this patient suffers a brain damage, so you could say that light reflex normal, you supposed to have light perception. So the doctor is not totally wrong, me neither.


Sunday, September 22, 2013

Parents

An 80 year old lady, with a hunch back brought her 50 year old son to the hospital. At first i wasn't sure who was the patient, until the son started talking. He opened his cloths and showed his belly, "someone cutting my stomach with scissors". There was no wound, and instantly we knew he was hallucinating. Right after he said that, his mother frowned. Worried  written all over her face, and i could see her helplessness. No matter how old you get, no matter how old your parents get, children will always be their main concern.

Another patient came in with schizophrenia paranoid, he had delusion that two Jewish inserted a chip in his brain, and spied on him. He became paranoid whenever someone was discussing something. And he could't stand thinking that everybody was judging his every action. All he ever wanted was just a simple attention and appreciation from his parents.

A 15 year old girl haunted by a bloody doll, with distorted face. She could visually see the doll and heard her speak whenever she was alone. She is frightened to the max, and this happened after her father passed away, and her mother started to abandon her. A parent actually have the power to destroy a kid's life, just like that.


Patient developed depression because her parents was very discipline at home. Another patient developed schizophrenia because his parents already gave up on him. Parents parents parents. the key person to almost every problem. 

And when my mother said she is satisfied with me not to get an A, surprisingly it healed my broken heart. I am wondering why parents play such important role in one's life. unexplainable. 

Wednesday, September 11, 2013

Anger

The weather is extremely hot lately. It is slowly boiling my temper. Everything seems frustrating. KKN (community services) registration is a mess. The system is down or not user friendly. In fact the whole university system is a disorder. My graduation is threatened with all kind of rubbish coming up. Everything is so slow. Even collecting log books take times and unnecessary energy. In this hot sunny weather, taking extra miles is tiring. The most frustrating thing is everybody doesn't seems as frustrate as I am.

I flipped through my patients medical record. five out of seven with "anger without reason". Nobody blames the weather. My patient seems perfectly fine to me. I can't find any unrealistic idea in everything he said. I am not giving up. A doctor told me that it takes patience to build rapport. So the next day, i talked to him again. Again, i felt that he is fine. On the way home, i saw a man, angrily scolding the lady who collect parking token. That man pound impatiently with his bike on all the bikes near him, cutting que to go infront, horning all the way. I was wondering does he considered as a psychiatry patient?

At least i dont get so angry that i killed someone. I just need to stop. and. think. Take a moment, take a breath. Nothing works with a clouded mind. Nothing works when you scold everyone around you. All you get is negative energy and unsatisfied stares. So, just stop. Just. Stop.

Saturday, August 31, 2013

Stase Anaesthesiology

Saw this really weird picture the first day I entered anaesthesiology department, named "the ideal anesthesiologist" and I was imagining every anaesthetist looks like this. Would it be really weird to have these alien-looking beings walking around the surgical rooms?
 It took me sometime to realise that anaesthetists play an important role in surgery, because all these while, I only see them sitting down doing nothing at the corner of the surgical rooms, or arranging pointless sports sessions every afternoon. Oh my goodness, I hated that the most. Being the lowest rank in the "hospital chain", we, the clinical students were asked to pick up tennis balls or be supporters in football matches. I supposed i support the team just to wish that everyone has good mood the next day. Everyday, I felt so tired, but I don't recall doing anything important or significant.

But, once in a while, I do enjoy the adrenaline rush. Intubation is fun! Saving people during emergency is more than fun! And to keep calm during emergency situation, is called professional. How often do you actually see that coming? Well, I met one resident who actually loves her job a lot, and a consultant who actually looks much more excited than the koas on simple procedures. He successfully showed me that they actually have to have brain to do their jobs. I am especially thankful that I were given chances and chances to do procedures when I did some mistakes in the procedures. The trust that I received worth more than I should received. Thanks for having patience with me. More than that, I should thank the patients too.

The sad thing is, I only have 10 days to do actual work, but another 18 days praying for the day to pass, and several hours looking at the clock, wishing to fast forward the time. Occupied, but can't do anything. My group's chief infected with dengue, and I was appointed to replace her. I have to say, it is super hard to talk to people who loves hierarchy, and to attend to attitudes and behaviours that practice hierarchy. Time to train my EQ.

Wednesday, August 7, 2013

August break

Still waking up 6 am in the morning and sleeping at 1 or 2am midnight. I wondered why my brain takes time to adapt to the holiday mood. Tons of pediatric books on my desk that i am not ready to give up. Pediatric OSCE dint turns up to be satisfying. I did some mistakes that i knew were wrong. So i waved goodbye to my 'A'. Very disappointing as i put in a lot of effort this time. But the fact that i am having one week holiday is comforting. I need to restore my sleep and rearrange my thought. All the circuit in my brain had been partly activated, but none was really functioning properly. The thought that I won't be seeing my favourite teacher after i left the department, is kinda depressing. Going back to those days where students don't really matters to the busy teacher.

You know, my wish last year actually came true. I am having my birthday exactly one day before my exam, so i have all the excuses to be alone and still be alright. But nonetheless, people around me been treating me really well, and I felt my egoness being lifted as I felt the importance of my existence. Got a new Powerbank. Muahaha!
This year, I been having a numbers of minion for my birthday. Haha. adorable. i like.

These few days i been having pretty much of a ghost ride. Watched "The Conjuring" with two girls, covering half of my face most of the time. Some jokers in the cinema imitating the movies by making three claps behind, which suddenly change the atmosphere in the cinema. LOL! it was supposed to be scary, not funny! Then the next day, we went to Lawang Sewu, famous haunted mansion in Semarang.
lawang Sewu means one thousand doors.

Also, We went to Sam Po Kong in Semarang. Amazed that many Muslim actually went there, even dressed in the chinese tradisional costume. Yes it is true, people here are much friendly and much open minded when it comes to religion. I dislike extremist to the max.


Oh its my Birthday on chinese calendar yesterday. Once in four years. And i just know that SamPo having birthday on the same day too.

Also we went for Buffet and shopping, though i am more of window shopping. Holiday hasn't end. I feel my footstep lighter, and things around me seems more alive.

Thursday, July 18, 2013

pediatric is depressing

I been thinking how to put this in words. But i guess i won't find correct words to describe them. haizzzzzz Pediatric is getting more and more depressing.

I cannot stand watching parents talking softly to their half dead children, cuddling them gently in their arms, carefully stroking them, tired but optimism. I don't understand how they manage to generate so much hope. It strike me hard. A father calmly accepting the news that there is no treatment for his three sons, anticipating same pattern of slow progressive muscle weakness and finally death in the coming years. A 3 year old kid, hardly move, as dead as a doll, and the mother happily explained that she responded for the first time. Another young mother, cheerful and proud of her 1 year old kid for staying alive with multiple fracture, meningoencephalitis, and multiple cellulitis.

oh nooo, these are crazy. Unhealthy kids, trapped in the bodies they hardly use. They are strong people. Sometimes watching those kids struggling to catch their breath, fighting to stay alive, I just wish i have super power and heal them with my touch. But it doesn't work that way. But their parents, these people are crazily amazing. Sometimes to a point that i wonder if it had over the psychology limits of a normal person. I couldn't imagine holding on and carry on for that long, without breaking apart.

Magic. They only exist in parents.


Hmmm.... So when i am hospitalised 23 years ago, did Magic actually happens?!

Sunday, July 7, 2013

Acara God Loves Me

The kids' eyes gleamed with anticipations. And their attentions being carried away by the MC from Kids Impact. In a wonderful afternoon, under the initiation of dr Juliani, Sp A, 40 kids suffered from chronic diseases, together with their parents, gathered around with 20 volunteers from Kids Impact and 14 co-assistant from RSUD Muntilan Pediatric Department in Sego Bamboo Resto, Yogyakarta.

The initial idea was to have an event to help heart disease patients, but in the end, it extended to include chronic disease patients. Everything was well arranged by our chief, Chen Wing Seng, who carried the responsibilities from buying tupperwares, ordering transport, and coordinating everything. Of course with others help. 3 buses were sent, 2 from RSUP Sardjito and 1 from RSUD Muntilan to pick up the participants for this event. Indeed, it was not a very grant event, but for the kids, perhaps it was.

There were a few activities, including face painting, nail arts, and coloring. It was entertaining to see the kids so excited about their favourite cartoons on their faces. Arvi had a very funny bee on his cheek, haha. I keep telling him that he should get an angry bird. Luckily the kids were not able to see their own faces, to realise that their Jerry is not brown, the hello kitty have asymmetrical eyes, or their angry birds smeared after a while. Despite that, satisfaction drew all over their faces. And the girls were so happy to finally get their nails painted. You see some of them maintaining their art by spreading 10 fingers and not moving them at all.
Me being painted on the face!
Everyone is provided with food. It was a great idea to serve the kids with tupperware they can bring home. It is not dr Juli's event, if it does not start and end with generosity. So there were a lot of free gifts, from schoolbags, to toys. I can imagine the participants leaping happily when they reached home. The kids were more than happy when they reached out to their toys. And there were two huge maskots in the event. I have to say Kids Impact actually helped A LOT! If the event were to depends solely on koas, i guess it would be bored as hell.
Our beloved dr Juli
dr Juli was having fun threatening us to sing in front. Her style of heating the atmosphere: " nanti bikin presentasi klo g nyanyi. Nanti ga dapat tanda tangan klo  ga nyanyi." @.@ Wing who happens to be healthy, presented with a very soothing song on "flying without wings". Bambi, Harry and Rizal apparently have pretty amazing voices. Rama's "Up Town Girl" sounds a bit... ... ... Haha, since i am the writer here, I decided not to talk about me =P. It turned out to be a karaoke session at the end of the event.
I am one of the poor victim
Sego Bamboo has a very lovely evening breeze. It is the end of the my week in Muntilan, so dr Juli made Wing, Rama and I wrote "love" letters for her. I doubt she will keep it, even though she said she will. "Life is like a box of chocolates, you never know what you're gonna get" when you have a teacher like dr Juli.
hmm.. wonder why Wing seems so big fat here.

Note from the author: Goodbye to fellow UII koas, till we meet again. 


Monday, July 1, 2013

Paediatrics in Muntilan

Everyone has a dream. Sometimes you got drifted away from yours, and more often you don't really remember what brings you here the in first place. Until, something reminded you.

I met this paediatric specialist in a small outskirt hospital. She is smart, that is one thing. She is super concern about our education. That is second. But one thing that amazed me the most. She is what i thought a doctor should be. Holistic and Care for the patients.

Patients missed out school, she bought books, uniforms and school bags for them. Patients control in poli came in with their achievement report, she bought toys for them as encouragement. Not lousy toys, but those expensive ones i don't even have as a kid. She feels for the babies. "Susah jadi bayi kan, ga bisa gerak." judging on the indonesian culture of swaddling babies so tightly they can't move. It takes a lot for someone to be kind. It takes a lot more for someone to take any realistic action. Can i not be amazed? I ll call her my teacher.

My teacher controls everything. Is like there is nothing she is not in control of. From as mild as body fluid to growth of a child. Is like God manipulating the human body on finger tips. From managing her students and nurses to the renovation of the pediatric's ward. Yes, one can easily called her an egoist. But i have to admit, i have the tendency to do that too, only that i can't because i am not capable of doing so.

5 weeks here, everyday is rushing by. My teacher made me realised that there is a lot more things i need to know. And a doctor can actually do much more than just refer a patient to a specialist that might not actually know what they should do. Especially in paediatric, parents tend to ask creative questions. I actually feels that i can do much more than just follow the protocol. Can you believe that my teacher actually spent around 8 hours per day with us? from visiting patients, discussion, to night discussion on whatapps. I wonder how she got so much energy and so much enthusiasm to teach and to "torture" us. But with this much of time spent, I felt that there is so much more knowledge to be absorbed, and i realised that so much more out there is yet to be discovered by me.

5 years in Indonesia, i met teacher who are smart, but no time. Or have a lot of time, but no brains. Only now i met this one teacher that have all brain, heart, soul and time. Most importantly, a role model for me (only that i have to be rich and smart to be her).

5 weeks, this is definitely not enough. 

Sunday, May 26, 2013

Excuse Me God

I used God as an excuse today. A friend (A) came late for work, and she happened to replace another friend (B) who need to go to church. I explained to my boss that friend B will not come today because she need to go to church. My boss misunderstood and thought that friend A came late because she had to go to church. And... I dint clear the doubt. I used church as an excuse for my friend to come late. My boss scolded a few words. I supposed she was not happy, but this is better than no excuse. God became an excuse, worse, an excuse to come late. I don't know why I let that happen.

When all medicine fails, my advice will be "just pray". Sounds like, any unsolved problem, just throw it to God. If God is my friend, He will be damn frust with me. Haha. However, I do believe in praying. Followers call it praying, Science calls it self-hypnosis. When you truly believe what you wish for, the chances of happening actually increase. God become the one to carry all the responsibility and all the damages that we had done. Will God be tired one day, with all these irresponsible human being, seeking for help when they are in the trouble that they created?

As much as i sound like i believe in God, i believe in Buddism. Happy Wesak Day!

Monday, April 22, 2013

Obgyn pwj

              It is hard to describe this place. Perhaps because I have been to Banjarnegara for obgyn rotation, Pwj became like a hell to me. Or perhaps the culture here is so much different from what I know. Like for example, the midwives don’t really care about us, I doubt they know our names. And the young midwives are so annoying that they never give us any chance to do anything. Their skills are not that good, yet they questioned our ability. They don’t thrust us koas in doing anything, so we are basically guests in the hospital. Alright enough about the midwives, the systems here kinda sucks. They don’t use lidocaine for all perineum suturing. They just asked the mothers to bite on a cloth. WTF! And they never use sterile glove when doing vagina examination. My goodness, I wonder who wanna deliver babies there.

                And next, the locals are not friendly. There was once, I went out for food. I sat on a table, waiting for my friends to arrive. Since the place was quite full, one family came and tried to conquer share my table with me. Okay. Then, the father took out a cigarette and smoke in front of me. There are plenty of spaces beside me, and I told him that he can sit there, so that my two friends can sit at the place that he was sitting. He answered me like I am a small girl asking for sweets. Frustrated, I just shifted away to the next table, and their whole family grinned like they just won a war. Crazy.

                So apparently I have a friend who I thought was quite close to us. She was from pwj. And we have no idea why when we reached pwj, she turned into someone we don’t know. Maybe, I am just assuming, she has a lot of works to do, and a lot of people to meet. Anyhow, we won’t let that stop us from exploring the city. This kabupaten is big actually, if you consider all the outskirt area. They have this angkut system, which was quite convenient, if you know how it works. The food is relatively more expensive, but not bad. Oh, and they eat goats and a subtype of duck (is call enthok), like a lot.  And we stayed near the paddy field where we have to pass by this big paddy field every morning. Every night, these frogs will start their orchestra with the crickets. Calm lifestyle.
on the way to hospital. with Twin Mountain behind us. 

They say this is the biggest beduk in the whole world.

Friday, March 22, 2013

Obgyn Banjarnegara


Tomorrow will be my last day here in Banjarnegara. Been having my clinical rotation here often, and this last one—obgyn is the most satisfying one. The reason being, the midwives are friendly and selfless, the specialist are humble and willing to teach, the akbid (student who studying to be midwives) won’t fight with you. One thing about studying here, you are given plenty of chances, to do anything you are capable of doing. Except IUD insertion (which became very rare), I did almost everything that is of my competency or beyond my competency. And for that, I am satisfied, and thank God I am given such opportunities.

The first time I see a woman giving birth, it was so shockingly scary. The whole perineum is like going to burst in a second. And then this head popped out, followed by the shoulder and the body. Amazing to see that satisfied wrote all over the mothers faces. All the crying and shouting, pain and suffering suddenly seems like nothing to them. I can even suture their perineum without pain killer because they are too concentrating in looking at their babies. (okay, without lidocaine only for the minor tears). I certainly can’t imagine how my mother looks like when I was born, especially when I am my mother’s first child, which means more pain and suffering.

Everything seems so difficult at first. To diagnose, to know which is normal which is not, to know what are the next steps to do, to help in delivering a newborn. Obgyn is like separate territory that I fear to step in, especially with the mothers yell and cry. They are like female tigers to me. After four weeks here and with the guidance of my beloved residents and midwives, I finally manage to help in a delivery confidently. More, i even did curettage, vacuum (only helping to pull actually), episiotomy etc etc. And i am not even asked to mop the floor or clean the gloves. We are considered like one of their colleague, actually a member of this maternal ward.

Thanks to the people here. Xie xie! I am glad.

Pigeon Holes, literally.

Sometimes i just don't understand why they must use a small wok to cook fried rice, when they have super a lot of customers.

ByeBye RSUD Banjarnegara

Wednesday, March 20, 2013

The Newborn


I carefully unfold the sterile linen and spread half across my shoulder, another half covered my arms, waiting for the baby. This is the first time I was asked to carry a newborn. During cesarean section, I was always the one assisting, doing suction and the lame job, but this time, since the perinatal staffs were on their way, I took over their job. The next thing I know, the doctor passed the baby right into my arms, and I carried it across the sterile room into another room for resuscitation. And he was moving, like really moving. God. But there was something wrong with the baby.

Atresia Ani, with various malformations in the extremities, the newborn did not cry at all. The anesthesia staff inserted endotracheal tube into his throat, trying to clear the airway, and did bagging, trying to make the baby continue breathing. I stood at one side, hoping the baby made it. The family members were called in to see their baby, and the grandmother cried instantly. Oh my… I almost lose my tears. The cry was so…. Sad.

The intubation did not succeed. It formed emphysema subcutis around the neck, and the baby neck grow bigger and bigger. There is no other way to help the baby except resuscitation, and even resuscitation made damage. I put on a glove, and took over the CPR. Such a small newborn, I don’t think he had a name yet. And I don’t even know whether I should called him a he, because his genital organ was ambiguous. Before long, he lossed his pulse, and his pupil enlarged. He was pronounced death.

Half an hour ago, he was still moving, in my arms.

Monday, February 11, 2013

CNY 2013

Maybe it’s the effect of getting old, when….

 This>>

 Doesn’t seem interesting

And This >>

Doesn’t seem interesting as well.

Okay. Maybe they actually are supposed to be interesting, because it is rare, very rare, to find barongsai (Indonesian) a.k.a Lion dance (English) a.k.a Tarian Singa (malay) in Indonesia, performed by jawanist people, hosted by a 5 stars hotel. Also, Long (Indonesian) a.k.a Dragon dance (English), are performed, with an acceptable quality. The hotel also invited a singer who can’t speak Chinese to sing Chinese song, so she does sound a bit like the contestant in “猜猜猜” where we have to guess what song she was singing. The food is nice and I should say Rp150,000 for a buffet this much, worth the price.

No matter how nice the food tasted, no matter how good the environment looked. There is still one thing deep down everyone’s heart. We hope this is the last Chinese New Year that we have to celebrate away from home. Final Year. No more extension please. 

Wednesday, February 6, 2013

Dermatology in ugm

Finally finished this "paranoid-emic" stase. the whole stase i was worried whether i got scabies from the patients, or chicken pox, or whatever skin diseases. People came in decent and nice, when they opened their jackets, wooow wait a minute.....

I learned a lot in the outskirt hospitals. Luckily i same group with lailai, and so luckily i get to sit GT's car to Klaten. and even though i had to fetch AZ to and fro, i still thank God i never meet any unfortunate incidences on the road. This is one of the stase that requires us to go to and fro for one to two hours everyday to outskirt, sometimes forced to use winding mountain roads. Thanks to chew and panji who willing to change with me, or not i guess i would have to take 3 hours just to go up that hospital, and another 3 hours to come back, Everyday! gosh. can die with my lousy riding skills.

My outskirt hospitals happened to be nice. A lot of cases and nice doctors. Fun learning with my groupmates. The only thing is, ya, the paranoid problem. i bathed more frequently and more conscious with my unhealthy skin. I start to realise i have acne problem, which my specialist actually suggested me to go for treatment.(omg i still think what's the point.) And i have dermatitis numularis, and my skin is super dry, i think i can almost see scales.

oh nooo, i cannot be a dermatology specialist. i can't stand looking at only skin diseases everyday. My mum used to say, skin specialist is the best, coz you usually only treat acne. well, mummy, you are wrong! There are far more variety of skin diseases, and, acne is not that easy to treat.